Hepatitis B learning needs assessment of family medicine trainees in Canada: Results of a nationwide survey

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THE CANADIAN JOURNAL OF GASTROENTEROLOGY

Original Article March 2011, Volume 25 Issue 3: 127-134

Hepatitis B learning needs assessment of family medicine trainees in Canada:

Results of a nationwide survey

JJ Sam, EJ Heathcote, DK Wong, DL Wooster, H Shah

BACKGROUND: An estimated 350 million people worldwide have chronic hepatitis B

(CHB), which is a major cause of cirrhosis and hepatocellular carcinoma.

OBJECTIVE: To assess the level of knowledge among family medicine trainees

regarding the identification and management of CHB.

METHODS: A questionnaire to assess knowledge regarding screening and management

of patients with CHB and cirrhosis was developed. The questionnaire was pilot

tested among primary care physicians, subsequently revised and distributed to

family medicine trainees across Canada through an online survey program

(QuestionPro).

RESULTS: A total of 158 trainees completed the questionnaire. Of these, 54% to

56% routinely offered vaccination against hepatitis A or hepatitis B virus

(HBV), and 42% regularly screened patients for HBV risk factors. The percentage

who recognized the need to screen highrisk populations for CHB, ie, individuals

from an HBV-endemic country, men who have sex with men, or intravenous drug

users was 73%, 66% and 74%, respectively. While less than 50% of respondents

used the appropriate HBV screening tests, 86% to 91% correctly interpreted

various HBV serological patterns. Only 3% recognized cirrhosis in our case

scenario. Almost 80% of respondents inappropriately preferred prescribing a

narcotic or nonsteroidal anti-inflammatory drug over acetaminophen (4%) for pain

control in a patient with cirrhosis. While less than 60% recognized HBeAg

negative CHB as an indication for referral and treatment, 90% would have

referred a patient in the immune-tolerant phase, even though treatment is not

indicated.

CONCLUSIONS: Knowledge gaps regarding CHB among family medicine trainees in the

areas of primary prevention, disease recognition and management of cirrhosis

were identified. Results suggest that opportunities to prevent potentially

life-threatening complications are being missed.

[Guest guest]

http://www.pulsus.com/journals/abstract.jsp?HCtype=Physician & sCurrPg=abstract & jn\

lKy=2 & atlKy=9995 & isuKy=968 & isArt=t & fromfold=Current &

THE CANADIAN JOURNAL OF GASTROENTEROLOGY

Original Article March 2011, Volume 25 Issue 3: 127-134

Hepatitis B learning needs assessment of family medicine trainees in Canada:

Results of a nationwide survey

JJ Sam, EJ Heathcote, DK Wong, DL Wooster, H Shah

BACKGROUND: An estimated 350 million people worldwide have chronic hepatitis B

(CHB), which is a major cause of cirrhosis and hepatocellular carcinoma.

OBJECTIVE: To assess the level of knowledge among family medicine trainees

regarding the identification and management of CHB.

METHODS: A questionnaire to assess knowledge regarding screening and management

of patients with CHB and cirrhosis was developed. The questionnaire was pilot

tested among primary care physicians, subsequently revised and distributed to

family medicine trainees across Canada through an online survey program

(QuestionPro).

RESULTS: A total of 158 trainees completed the questionnaire. Of these, 54% to

56% routinely offered vaccination against hepatitis A or hepatitis B virus

(HBV), and 42% regularly screened patients for HBV risk factors. The percentage

who recognized the need to screen highrisk populations for CHB, ie, individuals

from an HBV-endemic country, men who have sex with men, or intravenous drug

users was 73%, 66% and 74%, respectively. While less than 50% of respondents

used the appropriate HBV screening tests, 86% to 91% correctly interpreted

various HBV serological patterns. Only 3% recognized cirrhosis in our case

scenario. Almost 80% of respondents inappropriately preferred prescribing a

narcotic or nonsteroidal anti-inflammatory drug over acetaminophen (4%) for pain

control in a patient with cirrhosis. While less than 60% recognized HBeAg

negative CHB as an indication for referral and treatment, 90% would have

referred a patient in the immune-tolerant phase, even though treatment is not

indicated.

CONCLUSIONS: Knowledge gaps regarding CHB among family medicine trainees in the

areas of primary prevention, disease recognition and management of cirrhosis

were identified. Results suggest that opportunities to prevent potentially

life-threatening complications are being missed.